Fig. 2.

Cases of MVA.

(a) No coronary artery stenosis in angiography, no epicardial spasms and have inversion of lactic acid levels between intracoronary and coronary sinuses in ACh-provocation test.

(b) No coronary artery stenosis in angiography, no epicardial spasms and without inversion of lactic acid levels between intracoronary and coronary sinuses (no transcardiac lactate production) in ACh-provocation test and adenosine triphosphate-induced coronary flow reserve ratio (ATP-CFR) was below 2.5.

The transcardiac lactate production ratio then becomes positive during coronary circulation.

LER, lactate extraction ratio; Ao, aorta; CS, coronary sinus.